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4/19/2015 Injury Free Coalition for Kids 3 Objectives Understand the magnitude of childhood injuries Discuss properties of wheeled vehicles (eg.ATVs, dirtbikes, bicycles) making them risks for injury Learn specific risk factors for these type of injuries Discuss the public health approach to prevention As a group discuss potential interventions

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4/19/2015 Injury Free Coalition for Kids 4 The Injury Problem Leading cause of death from ages 1-44 years Results in more deaths in children than all other diseases combined #1 cause of years of potential life lost Costs hundreds of billions of dollars annually in US

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4/19/2015 Injury Free Coalition for Kids 19 Bicycles Responsible for more childhood injuries than any other consumer product except the automobile. More than 70% of all children ages 5-14 years ride bikes. Head injury is the leading cause of death in bicycle crashes –Non-helmeted riders are 14 times more likely to be involved in a fatal crash –98% of the bicyclists killed reportedly do not wear helmets. Bicycle helmets reduce the risk of head injury by 88% –National estimates report that bicycle helmet use among child bicyclists ranges from 15 percent to 25 percent. –Universal use of bicycle helmets could annually prevent deaths 39, ,000 head injuries Lifetime medical cost totalling between $134 and $174 million.

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4/19/2015 Injury Free Coalition for Kids 29 Key questions: Education What is the message—no ATV use or safer ATV use? What is the most important target audience—parents, adolescents? Dose of exposure needed to cause change in behavior? Does training really work? Can objective markers of physical readiness and/or maturity predict ATV risk? How effective is secondary prevention—can brief interventions work to motivate parents/youth after an ATV crash? Should we adopt a Graduated Driver’s Licensing approach to ATV safety?

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4/19/2015 Injury Free Coalition for Kids 34 Do laws work for ATVs? Study compared states with –No laws –Laws governing equipment only –Laws governing driver behavior States with no laws had injury rates twice as high as those with laws Several studies indicating a trend toward increased helmet use in jurisdictions with helmet laws Source: Helmkamp, AJPH, 2001

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4/19/2015 Injury Free Coalition for Kids 35 State-level Legislation 44 states have at least minimal ATV legislation ‐ Typical legislation includes parental supervision for young children, licensing/registration requirements, and bans on riding ATVs on public roads ‐ States without these laws have significantly higher death rates AJPH, 91: , November 2001

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4/19/2015 Injury Free Coalition for Kids 37 Enforcement Poor enforcement of existing policies is a major downfall Even in areas with motivated enforcement, laws may not apply on private property Substantial local variability in support for legislation, including ATV use on paved surfaces

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4/19/2015 Injury Free Coalition for Kids 38 Key questions: Enactment Do existing policies work to decrease injuries? What combination of policies is required to achieve effective prevention? How can we improve enforcement? Are other avenues for policy (insurance, liability) potentially more effective than legislation?

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4/19/2015 Injury Free Coalition for Kids 39 ATV Engineering Little is known (outside the ATV manufacturing industry) about the real-life performance characteristics of ATVs Less is known about vehicle performance with children on board Little is known about the performance characteristics of protective gear –Helmet effectiveness—reduction of 42% for mortality; 62% reduction in any head injury - Rodgers, Accident Anal Prev,1990 –Yet no significant difference in mean ISS between helmeted and non-helmeted riders. Helmet usage was not associated with a reduction in head/facial injuries. –Gittelman, Pediatrics, 2006 Engineering research from objective sources is lacking

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4/19/2015 Injury Free Coalition for Kids 44 Key questions: Engineering Can vehicles be modified to make them safe(r) for children? –If so, how: Speed regulators, stability control, roll bar/seat belts? Which is more important in safety: speed control or size of vehicle? –Will such vehicles be produced? –If produced, will they appeal to consumers? Can helmets be improved (more appealing, lighter, cooler) and retain effectiveness?

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4/19/2015 Injury Free Coalition for Kids 48 Non-legislative Efforts to Promote Helmet Use Royal – Inj Prev 2007 –Best effect with community based programs and those providing free helmets compared to in school or subsidized helmets –Education did not increase ownership of helmets Increase bike helmet use when parent uses helmet

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4/19/2015 Injury Free Coalition for Kids 50 Summary Significant injuries occur to children as a result of ATVs and Dirtbikes ATV/Dirtbike injury prevention challenges many accepted paradigms of injury control –May be some successes as deaths have declined Many questions exist about effective prevention strategies Successful ATV injury prevention will require: – Collaboration across all stakeholders – Rigorous application of behavioral, public health, and engineering sciences – New and creative approaches – Long term perspective